Dabigatran versus acenocumarol para la prevención del ictus en lafibrilación atrial. Análisis de impacto presupuestario en un departamento Sanitario

Abstract

Background: To Estimate, in the context of a Health Department of the Valencia HealthAgency, the budgetary impact ofthe widespread use of dabigatran at doses of 110 and 150 mg in patients with non-valvular atrial fibrillation (AF), regarding the current scenario with acenocoumarol the-rapy. Methods: Budget impact analysis of three scenarios of oral anticoa-gulation use inAF: a) current treatment with acenocoumarol, b) widespre-ad replacement of acenocoumarol for Dabigatran 110 mg and, c) idem at doses of 150 mg. The analysis was conducted from the perspective of the Valencia HealthAgency with a time horizon of one year (2009). The effec-tiveness and adverse effects were extrapolated from the RE-LY study, whi-le prevalence and cost data correspond tothe Health Department estimates in 2009. Results: We included 5889 patients (2.4% of the population > 18 years) diagnosed with AF, of which 3726 (63.2%) were treated with ace-nocoumarol. The total costs of each scenario were € 1,119,412 (€ 300 patient/year) for acenocoumarol, € 4,985,095 (€ 1,337 patient/year) for dabigatran 110 and € 4,981,226 (€ 1,336 patient/year) for dabigatran 150, with a budget impact of 1,037 euros/year per patient shifted from aceno-cumarol to dabigatran-150 . Conclusions: The high budgetary impact of moving to a scenario of widespread substitution of warfarin for Dabigatran supports the restriction of this therapeutic strategy to subgroups of patients at high risk or difficult control.